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Open Access 04-02-2025 | Heart Beat

Intimointimal intussusception in acute aortic dissection: a rare phenomenon

Auteurs: Gijs J. van Steenbergen, Rutger Brouwers, Erwin Tan

Gepubliceerd in: Netherlands Heart Journal

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Extras
video 1: Transesophageal echocardiography at 132°
Opmerkingen

Video online

The online version of this article contains one video. The article and the video are online available (https://​doi.​org/​10.​1007/​s12471-025-01933-8). The video can be found in the article back matter as “Electronic Supplementary Material”.
A woman in her 60s presented with decreased consciousness and respiratory distress after being found collapsed at home. She exhibited a systolic blood pressure difference of > 50 mm Hg between arms. Echocardiography performed in the Emergency Department revealed pericardial effusion, a transvalvular mobile structure through the aortic valve, and aortic regurgitation (Fig. 1a, b). Transoesofagal echocardiography confirmed the suspicion of aortic dissection, disclosing the unique feature on intimointimal intussusception—where the dissected intima prolapses through the aortic valve into the left ventricular outflow tract (LVOT) (Fig. 1c; see video 1 (Electronic Supplementary Material); [1]). Due to hemodynamic instability, the patient was not suitable for pre-operative computed tomography scan and was directly transferred for salvage sternotomy to relieve the cardiac tamponade. Intraoperative findings included a circumferential transverse intimal tear halfway along the ascending aorta, extending to the aortic valve which is characteristic for intimointimal intussusception. Following emergent ascending aorta replacement and aortic valve resuspension, the patient suffered extensive cerebral ischemia, leading to her passing.
This case underscores the importance of comprehensive echocardiographic evaluation in diagnosing aortic dissection, highlighting intimointimal intussusception as a critical, albeit rare, diagnostic clue.

Conflict of interest

G.J. van Steenbergen, R. Brouwers and E. Tan declare that they have no competing interests.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.
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Netherlands Heart Journal

Het Netherlands Heart Journal wordt uitgegeven in samenwerking met de Nederlandse Vereniging voor Cardiologie. Het tijdschrift is Engelstalig en wordt gratis beschikbaa ...

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Supplementary Information

video 1: Transesophageal echocardiography at 132°
Literatuur
1.
go back to reference Lajevardi SS, Sian K, Ward M, et al. Circumferential intimal tear in type a aortic dissection with intimo-intimal intussusception into left ventricle and left main coronary artery occlusion. J Thorac Cardiovasc Surg. 2012;144:e21–e3.CrossRefPubMed Lajevardi SS, Sian K, Ward M, et al. Circumferential intimal tear in type a aortic dissection with intimo-intimal intussusception into left ventricle and left main coronary artery occlusion. J Thorac Cardiovasc Surg. 2012;144:e21–e3.CrossRefPubMed
Metagegevens
Titel
Intimointimal intussusception in acute aortic dissection: a rare phenomenon
Auteurs
Gijs J. van Steenbergen
Rutger Brouwers
Erwin Tan
Publicatiedatum
04-02-2025
Uitgeverij
BSL Media & Learning
Gepubliceerd in
Netherlands Heart Journal
Print ISSN: 1568-5888
Elektronisch ISSN: 1876-6250
DOI
https://doi.org/10.1007/s12471-025-01933-8